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Mental health experts offer ideas to reduce gun violence

Volunteers Annabelle Andon, left, and Joanna Polk, remove items left at the memorials for the Marjory Stoneman Douglas High School shooting victims, Thursday, March 15, 2018, at Pine Trails Park in Parkland, Fla.  (Joe Cavaretta/South Florida Sun-Sentinel via AP)
Volunteers Annabelle Andon, left, and Joanna Polk, remove items left at the memorials for the Marjory Stoneman Douglas High School shooting victims, Thursday, March 15, 2018, at Pine Trails Park in Parkland, Fla. (Joe Cavaretta/South Florida Sun-Sentinel via AP)

Oklahoma City — In aftermath of a deadly shooting at a Florida high school, President Donald Trump called for a return to institutionalizing people with mental illnesses as a way to prevent mass shootings.

Locking up people with mental illnesses almost certainly wouldn't work, experts say, because they aren't responsible for most of the shootings in the United States.

A former student at Marjory Stoneman Douglas High School in Parkland, Florida, killed 17 people on Feb. 14. Information about the gunman's motive is preliminary at this point, though early reports suggest he had a history of troubling behavior.

Only about 3.5 percent of all violent crimes are linked to mental illness, and people who receive appropriate treatment are at no higher risk than the general population, said Dr. Louis Kraus, chief of child and adolescent psychiatry at Rush University Medical Center in Chicago. Prior violent behavior is a bigger risk, as is misusing drugs or alcohol, he said.

“Pointing fingers at the mentally ill is not the direction to go,” he said.

People talk about mental health in the aftermath of mass shootings for two reasons, said Charles Figley, director of the Tulane University Traumatology Institute. It's less contentious than discussing gun laws — almost everyone supports funding mental health treatment — and we have no other way to make sense of a mass killing, he said.

“There are things that people do that are out of the ordinary, and the only thing we can understand is they must be crazy,” he said.

Are predictions reliable?

Dr. Frank Ochberg, who advised the FBI on school shootings in the aftermath of the Columbine High School shooting in 1999, said a small number of mass shooters have a serious mental illness, like schizophrenia or bipolar disorder, that took away their ability to understand the difference between reality and delusion. An example is the shooter at Virginia Tech, who had been judged a danger to himself or others, but didn't receive the treatment he needed.

People remember those cases because the shooter's behavior can be bizarre, Ochberg said.

“We as a country tend to equate violence with those people because when it happens, it is so overblown and dramatic,” he said.

Other shooters have shown signs of hopelessness or social isolation, but didn't meet the criteria for a psychiatric diagnosis, Ochberg said. Still others act impulsively out of anger or jealousy, usually targeting co-workers or a romantic partner, who are psychopaths, who never developed consciences or the ability to feel compassion for others, he said.

A 2004 report from the National Institute of Justice, the U.S. Secret Service and the U.S. Department of Education that examined attacks that took place at schools from 1974 to 2000 found most shooters had had thoughts of suicide and felt depressed or desperate. The vast majority also had experienced some sort of loss before the attack, usually related to a perceived failure or a relationship.

“Most attackers appeared to have difficulty coping with losses, personal failures, or other difficult circumstances,” the report said.

Most people who are depressed or struggling to cope never act violently, however, so distress is a poor predictor.

A 2015 report from the Secret Service outlined more concrete signs that a person could be considering violence, such as “disturbing” communications about grievances, delusional beliefs or feelings of hopelessness; stalking or harassing others; changes in behavior or declines in functioning; withdrawing or increased conflict in relationships with others; and taking final acts like leaving goodbye messages or giving away belongings.

But some of those warning signs, like withdrawing socially, also are common to teens who won't try to attack anyone, Figley said. Any attempt to identify who will commit a mass shooting would fail to catch some dangerous people, and ensnare a number of people who never would have acted, he said.

“There's no way to do that, and if you do, there's going to be a lot of false positives,” he said.

What can be done?

The false positives still could be people who need help, however, Ochberg said. States could create a system for reporting concerns, assessing a person's risk of violence and matching that person to interventions to try to reduce his risk of harming himself or others, he said.

The U.S. Secret Service does “threat assessments” of people who might be a danger to federal employees or property, and checks in on them over time to make sure they aren't showing signs of escalating risk, Ochberg said. States could expand their civil commitment laws to require a person who might become a threat to check in with a “mentor,” undergo mental health treatment if necessary and perhaps surrender weapons, he said.

The goal would be to allow a person to keep as much of his or her dignity and civil liberties as possible, while reducing the odds he or she would harm others, Ochberg said.

“We haven't created a spectrum of responses that are effective,” he said.

Such a system would almost certainly face court challenges. In general, courts can only order a person to surrender weapons or undergo treatment if they have committed a crime, or been found to pose an imminent danger to themselves or others. Attempting to expand those laws would raise questions about what level of proof the state would have to meet, and how a person could challenge his or her assessment.

While a system for flagging potential shooters and reducing their risk may not work, people can make their communities somewhat safer by reaching out to people who seem to be alone or struggling, Figley said. Many shooters feel isolated and that no one values them, which can reinforce their darker thoughts, even if no one has deliberately mistreated them, he said.

“The number one strategy for preventing a kid like (the Florida shooter) is connections,” he said. Love “is a mechanism that reminds us that we are human beings and social beings, and that as long as we have that, things aren't as bad as they could be.”

All three experts said they thought changes to reduce access to high-powered weapons are necessary to decrease the toll of gun violence, but were skeptical Congress would act.

Some cases might be prevented by removing weapons from people in domestic violence cases, Ochberg said. “Hardening” potential targets with armed guards and other security measures could offer some protection, but it would come with the risk of only pushing violence to less-secure areas instead of preventing it, he said.

No idea is going to eliminate gun violence, but measures that somewhat reduce its toll are worth pursuing, Ochberg said.

“If we're going to have a bad outbreak of flu, we don't say it's all about washing your hands,” he said. “It's about putting all of these responses together.”

“We can't eliminate risk, but we can do a much better job of reducing risk.”

Meg Wingerter

Meg Wingerter has covered health at The Oklahoman since July 2017. Previously, she lived in Topeka, Kansas, and worked at Kansas News Service and The Topeka Capital-Journal, where she earned awards for business coverage. She graduated from... Read more ›